1/13. Femoral neck stress fracture: the importance of clinical suspicion and early review.Stress fracture of the femoral neck is rare and often initially missed. A high index of clinical suspicion is required in athletes presenting with a history of insidious onset, exertional groin pain and pain at the extremes of hip motion on examination. Regular review is recommended to prevent progression of the stress fracture to a displaced fracture, as this significantly worsens long term outcome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/13. Merkel cell carcinoma with bone metastasis: a case report.A case of Merkel cell carcinoma with bone metastasis is described. The patient, who had a history of Merkel cell carcinoma of the skin in the right cheek, had spontaneous pain in the right thigh. At the initial visit, the right hip range of motion was slightly limited, but there was no gait disturbance or abnormality in the radiographs of the right hip. However, the pain gradually increased and caused gait disturbance. The patient underwent surgical treatment. A bipolar type of femoral prosthesis was implanted into the femur, and sampling of cancellous bone was performed at the time of osteotomy. Pathological examination showed the findings of Merkel cell carcinoma. Merkel cell carcinoma is a rare malignant tumor of the skin, which usually occurs on the head, neck, or extremities and metastasizes to the lymph nodes. Although osseous involvement often occurs in the adjacent facial bones through direct invasion, distant osseous metastasis appears to be extremely rare.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/13. Transphyseal fracture-dislocation of the femoral neck: a case report and review of the literature.We describe a case of transphyseal hip fracture-dislocation in a 7.5-year-old patient who was treated initially by open reduction and internal fixation. Soon after the injury, the femoral head developed avascular necrosis. The treatment was focused on maintaining adequate hip range of motion and providing femoral head containment with a combined subtrochanteric femoral osteotomy and shelf acetabuloplasty. The patient's young age and good hip remodeling potential contributed to the favorable clinical outcome 3 years after the injury. The long-term prognosis remains guarded, however.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/13. Bilateral simultaneous hip fractures secondary to an epileptic seizure.A 30-year-old man sustained bilateral simultaneous displaced subcapital fractures of neck of femur during an epileptic tonic-clonic seizure. After admission to the hospital approximately 18 hours later, internal fixation of the fractures with dynamic hip screw was undertaken. Post operatively, he was managed by early motion and weight bearing on the second day. Despite the severity of the fractures and delayed surgery, satisfactory union of the fractures was noted at 6 months when bone densitometry was normal. At 3 years follow up, there was no sign of avascular necrosis of the femoral heads.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/13. In vivo acetabular contact pressures during rehabilitation, Part I: Acute phase.The authors conducted a two-part study to compare in vivo acetabular contact pressures during the acute and postacute phases of rehabilitation. This report compares in vivo acetabular contact pressures generated during selected "inpatient" rehabilitation activities and their relationship to pain, range of motion, and other clinical indicators. A pressure-instrumented Moore-type endoprosthesis was implanted in a 73-year-old woman who had sustained a femoral neck fracture. Acetabular contact pressures during the first 2 weeks after surgery were rank-ordered. Clinical data, including range of motion, manual muscle test grade, use of pain medication, and independence in gait, were collected simultaneously. Acetabular pressures did not follow the predicted rank order corresponding to the commonly prescribed temporal order of inpatient rehabilitation activities. Isometric hip extension and active hip flexion generated the highest pressures of all the studied activities, including those measured during gait activities. Isometric exercises, therefore, may not be entirely benign preparation for ambulatory activity. Clinical data did not correspond with peak pressure data, suggesting that observed responses to rehabilitation may not be dependable criteria for progressing the acute hip rehabilitation protocol. We discuss applications for rehabilitation programs based on hip contact pressure data as an initial attempt to formulate more defensible rehabilitation approaches for patients with acutely painful hips.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
6/13. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction: three cases of acute perioperative hypotension in noncardiac surgery.In this report we describe three cases of severe perioperative hypotension in noncardiac surgery patients. As systolic anterior motion of the mitral valve in combination with subaortic left ventricular outflow tract obstruction is an unrecognized cause for hypotension in noncardiac surgery patients, delayed diagnosis can result in erroneous treatment regimen. The aim of the present report is to provide an informative and brief synopsis of the pathophysiological consequences and diagnostic/therapeutic strategies for the perioperative management of systolic anterior motion.- - - - - - - - - - ranking = 6keywords = motion (Clic here for more details about this article) |
7/13. Unusual stress fracture of the femoral neck in a young adult not caused by excessive stress: a case report.A 30-year-old man complained of a 10-day history of gradual onset of severe left leg pain. He did not have any history of trauma or excessive training. Routine laboratory data showed no abnormal findings. He was able to perform passive motions of the hip joint without pain, but active motion of the left hip joint was impossible due to anterolateral thigh pain. Plain radiographs of the hip showed no abnormal findings. However, bone scintigraphy indicated trace accumulation in the left femoral neck, and T(1)-weighted magnetic resonance imaging showed a linear low signal on the inferomedial aspect of the femoral neck. Bone mineral density of the lumbar spine was 1.053 g/cm(2), which ruled out osteoporosis. The thigh pain was resolved 2 months after onset with conservative treatment, when plain radiographs showed sclerotic change and a reduction in the intensity of the low signal of T(1)-weighted magnetic resonance imaging. Our diagnosis of unusual stress fracture indicates that the possibility of stress fractures without bone fragility should be kept in mind when young adults complain of atypical pain even without evidence of unusual activities.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/13. Central fracture-dislocation of the hip with ipsilateral femoral neck fracture: case report.Central fracture dislocation of the hip with associated fracture of the femoral neck is rare. Treatment of choice consists of open reduction of the displacement and internal fixation of both fractures. Nevertheless, inadequate reduction of the burst fracture of the acetabulum may lead to hip arthritis, and the surgical approach to the femoral neck jeopardizes its vitality. In elderly patients early full motion and prompt physical rehabilitation can be achieved by total hip arthroplasty after fusion of the displaced femoral head to the acetabular wall.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/13. Nine-year functional nonunion of a femoral neck stress fracture: treatment with internal fixation and fibular graft. A case report.Open reduction and internal fixation utilizing a full thickness fibular graft was performed on a patient who presented with a 9-year-old functional nonunion of a femoral neck stress fracture. During this period, the patient had remained fully ambulatory, with intermittent episodes of hip pain. Our experience indicates that the treatment of old, nonunited stress fractures of the femoral neck with a fibular bone graft and internal fixation contributes to a successful result, lending support while stimulating osteogenesis as the nonunion heals. Use of rigid internal fixation will eliminate motion at the site of the fracture, enhancing incorporation of the bone graft and, thereby, speeding the patient's recovery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/13. Moore hemiarthroplasty functioning for 33 years: a case report.The Moore monopolar hemiarthroplasty is useful in the management of patients with femoral neck fractures, but long-term results may be associated with acetabular cartilage degeneration and hip pain. The authors report a case of long-term function of a Moore hemiarthroplasty. A 61-year-old woman sustained a fracture of the neck of the femur, which was treated initially with pinning. One year later, because the operation had failed, the patient underwent a Moore hemiarthroplasty. The prosthesis functioned well for 32 years, when she experienced increasing pain in the groin and a decreasing range of hip motion. Radiologic examination showed thinning of the acetabular cartilage so a total hip arthroplasty was performed. This case demonstrates that a unipolar arthroplasty is capable of long-term function, and with current improvements in stem fixation improved longevity can be expected.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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